Calcium hydroxide has been one of the most widely used biomaterials in pediatric dentistry for several decades. Its biological properties, high alkalinity, and ability to stimulate hard tissue formation have made it a cornerstone in pulp therapy procedures.
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✅ Clinical Applications in Pediatric Dentistry
In pediatric dentistry, calcium hydroxide is used primarily for vital pulp therapy procedures such as direct pulp capping, pulpotomy, and apexogenesis. It is also employed in endodontics for apexification of immature permanent teeth. The high pH (around 12.5) provides strong antimicrobial action and stimulates the release of bioactive molecules that promote reparative dentinogenesis (Schwendicke et al., 2016).
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Dental Article 🔽 Calcium Hydroxide in Pediatric Dentistry: Updated Uses, Benefits, and Clinical Evidence ... Calcium hydroxide (Ca(OH)₂) has been widely used for decades, especially in pulp therapy procedures, thanks to its outstanding biocompatibility and ability to stimulate dentin bridge formation.✅ Advantages of Calcium Hydroxide
1. Antibacterial properties: Its alkalinity eliminates many microorganisms present in infected pulp tissue.
2. Induction of dentin bridge formation: It stimulates odontoblastic activity, leading to reparative dentinogenesis.
3. Cost-effective: It is inexpensive and readily available compared to newer bioceramic alternatives.
4. Long history of use: Decades of clinical evidence support its efficacy.
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1. Solubility: It tends to dissolve over time, which may compromise long-term sealing ability.
2. Poor adhesion to dentin: Risk of microleakage and failure in long-term pulp protection.
3. Tunneling defects in dentin bridges: Histological studies show incomplete or porous dentin formation (Fuks, 2020).
4. Reduced success rates in long-term apexification: Newer materials such as mineral trioxide aggregate (MTA) and calcium silicate cements show superior results.
📊 Calcium Hydroxide in Pediatric Dentistry: Advantages and Limitations
| Aspect | Advantages | Limitations |
|---|---|---|
| Antibacterial Action | High alkalinity eliminates most microorganisms | Efficacy decreases over time as material dissolves |
| Dentin Bridge Formation | Stimulates odontoblast-like cells for reparative dentin | May produce porous or incomplete dentin bridges |
| Cost and Availability | Inexpensive and widely accessible | Inferior long-term outcomes compared to MTA |
| Clinical Evidence | Decades of successful use in pediatric pulp therapy | Declining preference due to newer bioactive materials |
💬 Discussion
Calcium hydroxide continues to be a valuable material in pediatric dentistry, particularly in regions where access to advanced biomaterials is limited. Its strong antimicrobial activity and ability to induce reparative dentinogenesis are undeniable strengths. However, modern clinical evidence indicates that calcium silicate-based materials such as MTA and Biodentine outperform calcium hydroxide in long-term pulp therapy outcomes (Torabinejad et al., 2018). The limitations of solubility, poor sealing, and incomplete dentin bridge formation highlight the need for careful case selection when using calcium hydroxide in pediatric patients.
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While calcium hydroxide remains a cost-effective and biologically favorable material for pediatric pulp therapy, its limitations should not be overlooked. Clinicians must balance its advantages against its shortcomings and consider the use of newer bioceramic alternatives when available. Future research may further clarify its role in modern pediatric dentistry, particularly in combination therapies or modified formulations.
📚 References
✔ Fuks, A. B. (2020). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Journal of Endodontics, 46(3), S49–S57. https://doi.org/10.1016/j.joen.2019.01.026
✔ Schwendicke, F., Brouwer, F., Schwendicke, A., & Paris, S. (2016). Different materials for direct pulp capping: Systematic review and meta-analysis. Journal of Dentistry, 54, 1–17. https://doi.org/10.1016/j.jdent.2016.08.005
✔ Torabinejad, M., Parirokh, M., & Dummer, P. M. H. (2018). Mineral trioxide aggregate and other bioactive endodontic cements: An updated overview – Part II: Other clinical applications and outcomes. International Endodontic Journal, 51(3), 284–317. https://doi.org/10.1111/iej.12843
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